Which symptom is most commonly associated with orthopnea?

• A. Shortness of breath that worsens when lying flat
• B. Sharp chest pain with inspiration
• C. Bilateral leg swelling without dyspnea
• D. Persistent coughing at night

Answer: (A)

Orthopnea is dyspnea that occurs when a person lies flat and often improves when upright. This happens because lying flat increases venous return to the heart, which can worsen pulmonary congestion in someone with heart failure or other cardiac limitations. The most telling sign is shortness of breath that worsens in the lying position, aligning with the option describing shortness of breath that worsens when lying flat.

The other options describe different symptoms. Sharp chest pain with inspiration points to pleuritic pain, not positional breathing difficulty. Bilateral leg swelling without dyspnea indicates edema that doesn’t necessarily involve the respiratory change that orthopnea reflects. A persistent cough at night can be seen with several conditions, including heart failure, but it isn’t the defining feature of orthopnea, which centers on how symptoms change with position.